Jerome D Poland MD LTD

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

2807770003 Issued in MN

Legal business name

JEROME D POLAND MD LTD

Doing business as

Crosby Eye Clinic/Remer

Practice address

9 Birch Street
Remer, MN 56672

Phone

(218) 566-2020

NPI assigned

Oct 24, 2007

Last updated

Jul 12, 2013By the provider in NPPES

Organization subpart

Yes

Parent organization

JEROME D. POLAND, M.D., LTD.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jerome D Poland, MD

Title

Admin Asst

Phone

(218) 546-5108

Specialties & licenses 2

Addresses

Other identifiers 4

Other names 1

• Crosby Eye Clinic/Remer Doing business as

Part of

Robert B Pendleton MD P

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1193184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1659550820",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 3RD AVE NE",
            "city": "CROSBY",
            "state": "MN",
            "postal_code": "564411665",
            "telephone_number": "218-546-5108",
            "fax_number": "218-546-5736"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9 BIRCH STREET",
            "city": "REMER",
            "state": "MN",
            "postal_code": "56672",
            "telephone_number": "218-566-2020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEROME D POLAND MD LTD",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "JEROME D. POLAND, M.D., LTD.",
        "enumeration_date": "2007-10-24",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "POLAND",
        "authorized_official_first_name": "JEROME",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ADMIN ASST",
        "authorized_official_telephone_number": "218-546-5108",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "MN",
            "license": "2807770003",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE PLUS DISP",
            "identifier": "566R0CR",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO GBA",
            "identifier": "CG9827",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "261527400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD MN",
            "identifier": "85038PO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crosby Eye Clinic/Remer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Remer, MN
• Providers in Remer, MN by specialty
• Eyewear Supplier in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.